Provider Demographics
NPI:1043031115
Name:FRAZIER, CHRISTIAN
Entity type:Individual
Prefix:PROF
First Name:CHRISTIAN
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S ASHLEY DR STE 600
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5300
Mailing Address - Country:US
Mailing Address - Phone:813-731-6709
Mailing Address - Fax:
Practice Address - Street 1:100 S ASHLEY DR STE 600
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5300
Practice Address - Country:US
Practice Address - Phone:813-731-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
FL101YP1600X, 171000000X, 175T00000X, 174H00000X
FL3758428405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171000000XOther Service ProvidersMilitary Health Care Provider
No175T00000XOther Service ProvidersPeer Specialist
No405300000XOther Service ProvidersPrevention Professional